Special report on implications of the ombudsman’s report on continuing care

Thousands of dementia sufferers, disabled people, and those with
a chronic illness could soon be reimbursed for fees they have been
wrongly made to pay for their long term care in nursing homes, if a
landmark recommendation by the new health service ombudsman is
acted on, writes Amy Taylor.

In her new report Ann Abraham recommends that four health
authorities should attempt to identify any patients who may have
wrongly been made to pay for their long term care in nursing homes,
after upholding complaints from relatives about four older people
who were incorrectly made to pay.

With half a million people currently in a long term care
setting, the recommendation could potentially cost the NHS millions
of pounds.

In the report, Abraham recognises that “significant numbers of
people and sums of money are likely to be involved”.

Paul Burstow MP, Liberal Democrat spokesperson for older people,
says: “Tens of thousands of elderly people have been illegally
forced to pay for long term care that should have been
free…it could cost taxpayers hundreds of millions of
pounds.”

Health authorities in Dorset, Wigan and Bolton, Berkshire and
Birmingham were subject to Abraham’s investigation, and one has
highlighted potential problems in carrying out her recommendation
in full.

A spokesperson from Birmingham Strategic Health Authority says
they “don’t see how it will be practically possible” to track down
records for everyone who believed they should have been eligible
for free long term care since the criteria to qualify took effect
in 1996.

She explains that although the authority felt it would be able
to review the case of people currently in the health or social care
system that for people outside of it, such as those who have died
since applying for care or had their application rejected and
therefore never received any, they were unsure of how to do
this.

Jonathan Ellis, health policy adviser for Help the Aged, agrees
that it will be very difficult for health authorities to carry out
the reassessment retrospectively. He says that they were actually
asked to do this by the government in 1998, but failed to carry it
out.

“To us at Help the Aged it seems remarkable that the scandal of
an ombudsman’s report is making people take notice,” he says.
Although he then goes on to add that bodies traditionally follow
ombudsman’s recommendations and that the message was particularly
strong. “It’s unprecedented for an ombudsman report to be so
damming of government policy as this,” he adds.

Ellis explains that there has been an “alarming amount of
inaction by the authorities” over the years, with more government
guidance being issued in 2001 after the Coughlan case. This
involved a judgement in 1999 on the eligibility criteria for
NHS-funded long term care.

It is this criteria that Abraham’s report states health
authorities should follow. By not doing so Ellis says they are
breaking the law. “I suspect this is why they are so willing to pay
up to the report, so to speak,” he explains, with it being
preferential to being sued.

However, Abraham is also critical of the guidance itself. She
says that although her investigation found it to have been
misapplied by some health authorities and trusts, there was also
“fundamental problems” with the system. “The department of health’s
guidance and support has not provided the secure foundation needed
to enable a fair and transparent system of eligibility for funding
to be operated across the country,” she says.

Help the Aged says the guidance is due to be reviewed in late
spring of this year and they see this as an opportunity to force
the health authorities to act. “We are calling on the government to
use this as a chance for a fundamental overhaul and to produce
national guidance to make the health authorities actually start the
reassessment process,” says Ellis. “This time we want it to have
teeth.”

A department of health spokesperson says strategic health
authorities will be told again they must review their continuing
care criteria.

The Alzheimer’s Society says that currently three-quarters of
people in long term care have Alzheimer’s or another form of
dementia, but many of them are forced to pay for this themselves.
“Callers to our helpline repeatedly tell us how little dementia
care the NHS will fund – even people in the palliative stage of
care are told they must finance their own care,” said Harry Cayton,
chief executive of the society.

The charity believes the problem comes in nurses, who do not
have any training in dementia, failing to recognise the presence or
nature of the disease, with sufferers still often able to move
around.

The charity also says this situation is made worse by the fact
that many of those who are trained to care for dementia sufferers
are not necessarily nurses, leading to them being incorrectly seen
as not providing nursing care.

For years the society has challenged these decisions, arguing
that dementia is a disease of the brain and therefore a health need
making sufferers entitled to NHS funded long term care, which is a
view the ombudsman’s report seems to share.

‘NHS funding for long
term care of older and disabled
people’ available
here